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Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men.

https://arctichealth.org/en/permalink/ahliterature13723
Source
Eur J Epidemiol. 2005;20(6):537-42
Publication Type
Article
Date
2005
Author
Bengt Järvholm
Stefan Lewold
Henrik Malchau
Eva Vingård
Author Affiliation
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Seweden. bengt.jarholm@envmed.umu.se
Source
Eur J Epidemiol. 2005;20(6):537-42
Date
2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Arthroplasty, Replacement, Hip - utilization
Arthroplasty, Replacement, Knee - utilization
Body mass index
Body Weight - physiology
Facility Design and Construction - manpower
Follow-Up Studies
Humans
Incidence
Industry - classification
Male
Middle Aged
Osteoarthritis, Hip - epidemiology - etiology - surgery
Osteoarthritis, Knee - epidemiology - etiology - surgery
Prospective Studies
Regression Analysis
Research Support, Non-U.S. Gov't
Risk assessment
Risk factors
Smoking - epidemiology
Sweden - epidemiology
Abstract
BACKGROUND: The objective of this study was to estimate the risk of severe osteoarthritis, with the need for arthroplasty, in the knee and/or hip according to body mass index (BMI) both within a normal range and in persons with high BMI. Furthermore, we wanted to study the significance of smoking. METHODS: This study identifies male construction workers participating in a national health control program (n = 320,192). The incidence rate for joint replacement was found by matching with the Swedish hospital discharge register between 1987 and 1998. BMI and smoking habit was registered at the time of the health examination. RESULTS: In total 1495 cases of osteoarthritis of the hip and 502 cases of osteoarthritis of the knee were identified and included in this analysis. The incidence rate was found to increase linearly to the BMI even within low and 'normal' BMI. The relative risk for osteoarthritis of the hip was more than two times higher in persons with a BMI of 20-24 than in men with a BMI 17-19. There was almost a doubling of the risk of severe knee osteoarthritis with an increase in BMI of 5 kg/m2. Smoker had a lower risk of osteoarthritis than non-smokers and ex-smokers. CONCLUSIONS: BMI is an important predictor of osteoarthritis even within normal BMI. A decreased risk of osteoarthritis of the hip was found in smokers, but the effect was weak compared to that of BMI or age. Contrary to studies of radiographic osteoarthritis our study indicates higher risk of hip than of knee osteoarthritis.
PubMed ID
16121763 View in PubMed
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Comparing variation across European countries: building geographical areas to provide sounder estimates.

https://arctichealth.org/en/permalink/ahliterature262629
Source
Eur J Public Health. 2015 Feb;25 Suppl 1:8-14
Publication Type
Article
Date
Feb-2015
Author
Lau C Thygesen
Cristobal Baixauli-Pérez
Julián Librero-López
Natalia Martínez-Lizaga
Manuel Ridao-López
Enrique Bernal-Delgado
Source
Eur J Public Health. 2015 Feb;25 Suppl 1:8-14
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip - utilization
Arthroplasty, Replacement, Knee - utilization
Catchment Area (Health) - statistics & numerical data
Delivery of Health Care - standards - statistics & numerical data
Denmark
England
Geography
Health Services Accessibility - statistics & numerical data
Health Services Research
Healthcare Disparities - statistics & numerical data
Hospitals - utilization
Humans
Models, Statistical
Myocardial Infarction - therapy
Percutaneous Coronary Intervention - economics - methods
Portugal
Residence Characteristics
Small-Area Analysis
Abstract
In geographical studies, population distribution is a key issue. An unequal distribution across units of analysis might entail extra-variation and produce misleading conclusions on healthcare performance variations. This article aims at assessing the impact of building more homogeneous units of analysis in the estimation of systematic variation in three countries.
Hospital discharges for six conditions (congestive heart failure, short-term complications of diabetes, hip fracture, knee replacement, prostatectomy in prostate cancer and percutaneous coronary intervention) produced in Denmark, England and Portugal in 2008 and 2009 were allocated to both original geographical units and new ad hoc areas. New areas were built using Ward's minimum variance methods. The impact of the new areas on variability was assessed using Kernel distribution curves and different statistic of variation such as Extremal Quotient, Interquartile Interval ratio, Systematic Component of Variation and Empirical Bayes statistic.
Ward's method reduced the number of areas, allowing a more homogeneous population distribution, yet 20% of the areas in Portugal exhibited less than 100 000 inhabitants vs. 7% in Denmark and 5% in England. Point estimates for Extremal Quotient and Interquartile Interval Ratio were lower in the three countries, particularly in less prevalent conditions. In turn, the Systematic Component of Variation and Empirical Bayes statistic were slightly lower in more prevalent conditions.
Building new geographical areas produced a reduction of the variation in hospitalization rates in several prevalent conditions mitigating random noise, particularly in the smallest areas and allowing a sounder interpretation of the variation across countries.
PubMed ID
25690124 View in PubMed
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Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement.

https://arctichealth.org/en/permalink/ahliterature154464
Source
J Bone Joint Surg Am. 2008 Nov;90(11):2337-45
Publication Type
Article
Date
Nov-2008
Author
Gillian Hawker
Jun Guan
Andy Judge
Paul Dieppe
Author Affiliation
Division of Rheumatology, Department of Medicine, Women's College Hospital, 76 Grenville Street, 8th Floor, Room 815, Toronto, ON M5S 1B2, Canada. g.hawker@utoronto.ca
Source
J Bone Joint Surg Am. 2008 Nov;90(11):2337-45
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthroplasty, Replacement, Knee - utilization
Arthroscopy - trends - utilization
England
Female
Humans
Knee Joint - pathology
Male
Middle Aged
Ontario
Osteoarthritis, Knee - surgery
Abstract
The role of knee arthroscopy in the management of osteoarthritis is unclear. The purpose of this study was to examine patterns of use of knee arthroscopy, overall and by diagnostic and sociodemographic subgroups, in countries with comparable health-care systems.
Administrative databases were used to construct cohorts of adults, twenty years of age or older, who had undergone their first knee arthroscopy in 1993, 1997, 2002, or 2004 either in Ontario, Canada, or in England. For each year, age and sex-standardized rates of knee arthroscopy per 100,000 population were determined overall and by diagnosis, sex, age, and income quintile. Regression analysis, with control for confounders, was used to examine predictors of readmission for primary total knee replacement up to five years after an index knee arthroscopy performed in 1993 or 1997. We also analyzed the records of patients who had undergone primary knee replacement in 2002 to determine the rates of knee arthroscopy in the two years prior to that replacement.
In both countries, the proportion of arthroscopic procedures performed to treat internal derangement or dislocation of the knee increased over time; the rates were highest in the highest income quintiles. The study revealed that 4.8% of the patients in England and 8.5% of those in Ontario who had an arthroscopy to treat osteoarthritis in 1997 received a knee replacement within one year after that procedure. The risk of readmission for knee replacement was greater in association with a diagnosis of osteoarthritis, female sex, and an older age at the time of the arthroscopy. Of the patients who had a primary knee replacement in 2002, 2.7% in England and 5.7% in Ontario had undergone a knee arthroscopy in the previous year; the likelihood of the patient having had a prior arthroscopy increased with higher income and increasing age.
Variations in knee arthroscopy rates according to age, sex, income, and diagnosis were identified in both countries. Research to determine if these differences are consistent with need is warranted.
PubMed ID
18978402 View in PubMed
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Past incidence and future demand for knee arthroplasty in Sweden: a report from the Swedish Knee Arthroplasty Register regarding the effect of past and future population changes on the number of arthroplasties performed.

https://arctichealth.org/en/permalink/ahliterature14079
Source
Acta Orthop Scand. 2000 Aug;71(4):376-80
Publication Type
Article
Date
Aug-2000
Author
O. Robertsson
M J Dunbar
K. Knutson
L. Lidgren
Author Affiliation
Department of Orthopedics, Lund University Hospital, Sweden. otto.robertsson@ort.lu.se
Source
Acta Orthop Scand. 2000 Aug;71(4):376-80
Date
Aug-2000
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Arthritis, Rheumatoid - epidemiology - surgery
Arthroplasty, Replacement, Knee - utilization
Female
Forecasting
Humans
Incidence
Knee Injuries - epidemiology - surgery
Male
Middle Aged
Needs Assessment - trends
Osteoarthritis, Knee - epidemiology - surgery
Population Growth
Registries
Reoperation - statistics & numerical data - trends
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
By combining data from the Swedish Knee Arthroplasty Register and Swedish census registers we have calculated the past age-specific incidence of primary knee arthroplasties and predicted the demand. During the last 20 years, osteoarthrosis has accounted for the largest increase in number of knee arthroplasties while operations for rheumatoid arthritis remained constant. The mean yearly number of operations between the periods 1976-1980 and 1996-1997 increased more than five-fold, while only 6% of that increase could be explained by changes in the age-profile of the population. Most operations were performed on persons of 65 years and older who also had the largest increase in incidence. By using the incidences for 1996 and 1997 and taking into account the expected future changes in the age profile of the Swedish population, we estimate that, in the absence of an effective preventive treatment, the number of knee arthroplasties will increase by at least one third until 2030.
PubMed ID
11028886 View in PubMed
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A prospective population-based study of the predictors of undergoing total joint arthroplasty.

https://arctichealth.org/en/permalink/ahliterature167265
Source
Arthritis Rheum. 2006 Oct;54(10):3212-20
Publication Type
Article
Date
Oct-2006
Author
Gillian A Hawker
Jun Guan
Ruth Croxford
Peter C Coyte
Richard H Glazier
Bart J Harvey
James G Wright
Jack I Williams
Elizabeth M Badley
Author Affiliation
University of Toronto, Toronto, Ontario, Canada. gillian.hawker@wchospital.ca
Source
Arthritis Rheum. 2006 Oct;54(10):3212-20
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - utilization
Arthroplasty, Replacement, Knee - utilization
Female
Humans
Male
Middle Aged
Multivariate Analysis
Ontario
Osteoarthritis, Hip - physiopathology - psychology - surgery
Osteoarthritis, Knee - physiopathology - psychology - surgery
Patient Acceptance of Health Care
Prognosis
Prospective Studies
Questionnaires
Severity of Illness Index
Time Factors
Abstract
To examine prospectively the predictors of time to total joint arthroplasty (TJA).
This was a prospective cohort study with a median followup time of 6.1 years. We included participants from an existing population-based cohort of 2,128 individuals, ages 55 years and older with disabling hip and/or knee arthritis and no prior TJA, from 2 regions of Ontario, Canada, 1 urban with low TJA rates and 1 rural with high rates. The main outcome measure was the occurrence of a TJA based on procedure codes in the hospital discharge abstract database.
At baseline, the mean age of the patients was 71.5 years, 67.9% had a high school education or higher, 73.4% were women, the mean arthritis severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) score was 41.1 (maximum possible score 100), and 20.0% were willing to consider TJA. Greater probability of undergoing TJA was associated with higher (worse) baseline WOMAC scores (hazard ratio [HR] 1.22 per 10-unit increase, P or=82 years; P
PubMed ID
17009255 View in PubMed
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The relationship between variations in knee replacement utilization rates and the reported prevalence of arthritis in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature206715
Source
J Rheumatol. 1997 Dec;24(12):2403-12
Publication Type
Article
Date
Dec-1997
Author
P. Coyte
P P Wang
G. Hawker
J G Wright
Author Affiliation
Department of Health Administration and Institute for Policy Analysis, University of Toronto, Ontario, Canada.
Source
J Rheumatol. 1997 Dec;24(12):2403-12
Date
Dec-1997
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthritis - epidemiology
Arthroplasty, Replacement, Knee - utilization
Female
Humans
Male
Middle Aged
Ontario - epidemiology
Physician's Practice Patterns
Prevalence
Regression Analysis
Abstract
To determine the relationship between regional variations in knee replacement (KR) utilization rates in Ontario, Canada, and the reported prevalence of arthritis and rheumatism as a chronic health problem.
Utilization data were acquired from the Canadian Institute for Health Information for KR procedures performed in Ontario between fiscal years 1984 and 1990. Census information was obtained from Statistics Canada. Disease prevalence data were derived from the 1990 Ontario Health Survey (OHS). Public Health Units (PHU) were used as the unit of analysis, with utilization rates defined as the number of KR performed on all PHU residents (irrespective of where these procedures were performed) divided by the population. Direct methods were used to standardize utilization for age, sex, and disease prevalence. The extremal quotient, the weighted coefficient of variation, and the systematic component of variation were used as measures of variation. The relationship between the number of KR performed in each age-sex-year strata and various demographic (age and sex), disease prevalence, and regional dummy variables was estimated using a Poisson regression model.
Regional variation in the standardized utilization of KR surgery was wide, but declined over the study period; the extremal quotient fell from 8.0 to 3.3, the weighted coefficient of variation fell from 0.49 to 0.30, and the systematic component of variation fell from 0.20 to 0.17. Variation in the provision of KR surgery remained even after controlling for the demographic composition of the population and disease prevalence. Moreover, while demographic, regional, and temporal covariates were significant (p 0.05).
This study merged population based reports of disease prevalence with administrative data to account for regional variations in utilization. While regional variations in KR surgery have fallen over time, variations remain even after adjusting for patient reported disease prevalence. The finding that demographic variables and the reported prevalence of disease were poorly correlated suggests that current area variation studies may not be adjusting fully for disease prevalence or severity.
PubMed ID
9415650 View in PubMed
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Seasonality of service provision in hip and knee surgery: a possible contributor to waiting times? A time series analysis.

https://arctichealth.org/en/permalink/ahliterature170439
Source
BMC Health Serv Res. 2006;6:22
Publication Type
Article
Date
2006
Author
Ross E G Upshur
Rahim Moineddin
Eric J Crighton
Muhammad Mamdani
Author Affiliation
Primary Care Research Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada. ross.upshur@sw.ca
Source
BMC Health Serv Res. 2006;6:22
Date
2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - utilization
Arthroplasty, Replacement, Knee - utilization
Cross-Sectional Studies
Humans
Ontario
Outcome and Process Assessment (Health Care) - methods
Retrospective Studies
Seasons
Surgery Department, Hospital - organization & administration - utilization
Time Factors
Utilization Review
Waiting Lists
Abstract
The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario.
We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements.
There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p
Notes
Cites: CMAJ. 1994 Mar 15;150(6):917-218131124
Cites: Arch Intern Med. 1990 Nov;150(11):2286-901978648
PubMed ID
16509992 View in PubMed
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Setting priorities on waiting lists: point-count systems as linear models.

https://arctichealth.org/en/permalink/ahliterature185948
Source
J Health Serv Res Policy. 2003 Jan;8(1):48-54
Publication Type
Article
Date
Jan-2003
Author
David Hadorn
Author Affiliation
Western Canada Waiting List Project, Department of Community Health Sciences, University of Calgary, Alberta, Canada.
Source
J Health Serv Res Policy. 2003 Jan;8(1):48-54
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Arthroplasty, Replacement, Hip - utilization
Arthroplasty, Replacement, Knee - utilization
Canada
Health Care Rationing - methods - statistics & numerical data
Health Priorities - classification - statistics & numerical data
Health Services Accessibility - standards
Humans
Linear Models
National Health Programs - organization & administration - statistics & numerical data
Patient Selection
Pilot Projects
Primary Health Care
Severity of Illness Index
Waiting Lists
Abstract
The Western Canada Waiting List Project (WCWL) is a federally funded initiative designed to develop tools for managing waiting lists. The principal tools developed by WCWL are point-count measures that assess the severity of patients' conditions and the extent of benefit expected from wait-listed services. Points are assigned according to the severity of patients' symptoms and clinical findings. Points on each factor are added and the total score is considered indicative of relative clinical urgency. Such point-count measures function as linear models from a statistical perspective. This paper describes the relevance of this functional relationship for the development and validation of priority criteria.
PubMed ID
12683434 View in PubMed
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Stable occurrence of knee and hip total joint replacement in Central Finland between 1986 and 2003: an indication of improved long-term outcomes of rheumatoid arthritis.

https://arctichealth.org/en/permalink/ahliterature166862
Source
Ann Rheum Dis. 2007 Mar;66(3):341-4
Publication Type
Article
Date
Mar-2007
Author
Tuulikki Sokka
Hannu Kautiainen
Pekka Hannonen
Author Affiliation
Jyväskylä Central Hospital, Arkisto/Tutkijat, Jyväskylä 40620, Finland. tuulikki.sokka@ksshp.fi
Source
Ann Rheum Dis. 2007 Mar;66(3):341-4
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Aged
Arthritis, Rheumatoid - surgery
Arthroplasty, Replacement, Hip - utilization
Arthroplasty, Replacement, Knee - utilization
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Retrospective Studies
Sex Factors
Abstract
Total joint replacement (TJR) surgery is an important severe long-term outcome of rheumatoid arthritis, but relatively little is known about changes of its incidence in patients with rheumatoid arthritis over the past two decades.
A population-based, retrospective, incidence case review was conducted to analyse the frequency of primary TJR surgery of the knee and hip in all patients, and specifically in patients with rheumatoid arthritis in Central Finland between 1986 and 2003. Patients with TJR surgery of the knee and hip were identified in hospital databases over the 18-year period. Age-standardised incidence rate ratios for the primary TJR of the knee and hip were calculated, stratified to sex and diagnosis, with 1986 as the reference value.
In patients without rheumatoid arthritis the age-adjusted incidence rate ratios (with 95% CI) for TJR of the knee increased 9.8-fold from 1986 to 2003 in women and men, and for TJR of the hip 1.8-fold in women and 2-fold in men. By contrast, no meaningful change was seen over this period, in age-adjusted incidence rate ratios for TJR of the knee or hip in patients with rheumatoid arthritis, ranging from 0.7 to 1.2 in 2003 compared with 1986.
The prevalence of TJR surgery has increased 2-10-fold in patients without rheumatoid arthritis patients, associated with an ageing population, but has not increased in patients with rheumatoid arthritis between 1986 and 2003. These data are consistent with emerging evidence that long-term outcomes of rheumatoid arthritis have improved substantially, even before the availability of biological agents.
Notes
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PubMed ID
17068067 View in PubMed
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Waiting times and patient perspectives for total hip and knee arthroplasty in rural and urban Ontario.

https://arctichealth.org/en/permalink/ahliterature172293
Source
Can J Surg. 2005 Oct;48(5):355-60
Publication Type
Article
Date
Oct-2005
Author
Matthew G Snider
Steven J MacDonald
Ralph Pototschnik
Author Affiliation
Faculty of Medicine, University of Western Ontario.
Source
Can J Surg. 2005 Oct;48(5):355-60
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip - utilization
Arthroplasty, Replacement, Knee - utilization
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Health Services Needs and Demand - trends
Health Services Research
Humans
Ontario
Patient Acceptance of Health Care - statistics & numerical data
Referral and Consultation - statistics & numerical data
Retrospective Studies
Rural Population
Urban Population
Waiting Lists
Abstract
The demand for total hip and total knee arthroplasties is increasing as are the waiting times for these procedures. Because of the differences between rural and urban areas in terms of the provision of arthroplasty services and between the 2 patient groups, patient perspectives of waiting times may also be different.
To compare waiting times for initial orthopedic consultation and total hip and knee arthroplasties in rural Ontario (Stratford) and in urban Ontario (London), and to compare patient perspectives of these waiting times, we mailed a survey to all 260 patients who underwent total hip or total knee arthroplasty between June 1, 2000, and June 1, 2001. The survey asked for the length of wait for consultation and for surgery, acceptability of waiting time for surgery, the effect of waiting on health and what an acceptable waiting time would be. Of the 260 surveys mailed 202 (78%) were returned. We reviewed the charts of the respondents to determine the actual waiting times.
The actual waiting times (mean [and standard deviation]) for initial consultation were significantly (p
Notes
Cites: Ann R Coll Surg Engl. 2001 Mar;83(2):128-3311320923
Cites: J Arthroplasty. 2000 Oct;15(7):877-8311061448
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Comment In: Can J Surg. 2005 Oct;48(5):349-5116248130
PubMed ID
16248132 View in PubMed
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10 records – page 1 of 1.